The data is bad, preflight test not nearly enough

There is no shame in making mistakes, only in failing to correct them. Mayor Kawakami, Dr. Berreman, the way we have reopened is a mistake. We can do it right.

Opening Kaua‘i without a properly timed mandatory quarantine, without a second test, and without extensive surveillance testing in place, is a serious mistake.

Kaua‘i has 5% of the state’s population and on October 14th a miniscule .001% of the cases in Hawai‘i.

And yet in the last three weeks you’ve accepted more than 10% of the state’s travelers and opened with the same protocol as O‘ahu which has 69% of the state’s population and 89% of the known cases. This was a huge oversight.

Put another way, on October 14th, O‘ahu had more than a thousand times the cases on Kaua‘i. Yet you allowed others to dictate that you open in the same manner.

You invited travelers from high covid areas into your medically fragile 70,000 person community with the lowest covid case count in the US, and 99.9% of the world.

An international story will soon be written as to how the neighbor island leaders allowed their islands to be opened like O‘ahu, by interests mainly on O‘ahu, and in doing so fully squandered their isolated location and covid free gift. Kaua‘i will be the starkest example.

With some imagination and targeted marketing you can bring thousands of high value longer term guests to the island, as the Cayman Islands and others are doing. I’ve yet to see a single article heralding Kaua‘i’s incredibly unique virtually covid free status. Instead the most motivated on the mainland remain unaware of us as they ponder how to move to New Zealand.

You have evidence from Alaska, Tahiti, the Bahamas, and other destinations that make it clear a single preflight test will let too much covid through and eventually result in community spread.

From Alaska’s extensive data collection we know that 19% of their infected Pacific Islanders and Hawai‘ians end up in the hospital – more than twice any other group. We also know that at least 3 out of 1,000 travelers are infected and missed with a single preflight test. I suspect a close reading of the data will soon show it to be even higher.

Mayor Kawakami, Dr. Berreman, please protect your citizens and correct this error – before it is too late. I’m not sure you have even a week to change course.

Ignore, while you still can, the shortsighted state narrative that travelers are not the problem, and that community spread is. That may be partly and depressingly true on O‘ahu, but here on Kaua‘i every traveler is a new patient zero and a potential seed for community spread.

Let O‘ahu have had its own opening protocol – and invite thousands of travelers in. There is an argument that O‘ahu’s percent of active cases and community spread matches or exceeds the levels in the communities most travelers come from. But that argument holds zero water on Kaua‘i, Maui, and to a lesser degree on the Big Island.

However reluctantly, you ultimately chose to go along with our state leadership’s disingenuous argument that the choice was to open or not open – which is simply not true. Your many local doctors who focused on the data, the math, and the science were labeled by state leadership as elitists, fearmongers, and stupid. Yet they, and the lessons from others, gave you a clear path to opening far more safely – by cutting the 14 day quarantine in half and requiring a second test to exit it.

Don’t wait for your tier system, the speed and trajectory of new cases is alarming enough. It is not too late.

Mayor Harry Kim has acknowledged that he was not forced into reopening, and to his credit twice threatened to opt out. He brought the governor back to the table, and then in a moment of weakness, which he now laments, accepted a nonsensical second test upon arrival. For many travelers it was hours after they took their first test – which is absurd. Last week, Mayor Kim stated “the only thing I regret, I should have pushed harder.”

It was incompetent state leadership that allowed the virus to explode in June on O‘ahu, disproportionately harming our pacific islander communities. In August, myself and others clearly warned that community spread was setting in on the Big Island (

That same leadership is now saying the Big Island’s same day of arrival second test was their promised “10% surveillance testing.” You know this is misleading and doesn’t pass the straight face test. We know it usually takes at least 5-7 days for viral loads to become detectable.

Your own voluntary “$150 visitor testing,” with 2% participation (only 50-60 visitors tested last week) is, on balance, a failure. Let’s admit it, and then fix it.

Mayor Kawakami, Dr. Berreman, you can more safely open this island – wisely and with some creativity so you can keep it open. No half steps. No more pleading and polite requests. Lead us. We’ll support you. Stop following those who are not putting your citizen’s interests first.

This is surely the most important moment in your career. Please raise your game for all of us.


Steve O’Neal lives on the north shore of Kaua‘i with his three young children and has worked for the UN as a disaster response assessment lead.

  1. goat November 12, 2020 6:51 am Reply

    the number of cases will continue to spread until there are stricter restrictions. in agreement with mr. o’neal, things need to change. the majority of people in hawai’i have no idea how it is on the “mainland.” there is a reason why the number of infections are at an all time high.

    in my understanding, all you need to do is take a test seventy-two hours before traveling. so if i test negative on a thursday, and then decide to go to a function with groups of people the next day, i could become infected in those two days before getting on a plane. unlike people in hawai’i, many on the “mainland” do not care about the virus, or follow guidelines. if someone is asymptomatic, they could go days without knowing they are infected, yet continue to spread the virus to citizens of kaua’i.

    with numbers continuing to skyrocket, there needs to be tougher restrictions, not looser ones, or it will become a huge problem in hawai’i, and on kaua’i.

  2. Dr Jim November 12, 2020 7:26 am Reply

    It is time to consider how our current situation is impacting the island. We need to look at epidemiology models and project the impact we are going to feel based on the first few weeks of data.

    Keep in mind if other locations are any indication, even if we were to shut down now, the trajectory of cases will continue to increase for about two weeks, and it will take around an additional 4 (6 total) weeks to return to the level they are at today. So we wont really be improving for over a month after we shut down again.

    I agree that recognizing that we have an emerging problem, and responding quickly may indeed save lives and protect our community. With the two test, 6 day quarantine restrictions we can have a level of tourism that will sustain the island for the next year, after which we can we return to a more robust tourism trade. If we consider the demand for working tourists who are looking for anywhere other than the mainland cities to work from remotely, I believe we can improve our economic outlook locally and generate significant income tax revenue ( remote workers are liable for taxes where they live- Hawaii).

    Perfect? No. But probably close to the best balance of care for our community, maintaining our medical system, not overwhelming our contact tracing system, keeping our schools open and safe for our keiki, keeping kapuna out of harm’s way, and providing some inflow of income to the island. Please remember to step up and help those of our community that are more directly impacted by the diminished tourist trade, especially those that are without an economic buffer. Have empathy and compassion for those that are struggling financially and emotionally. These people, too, are the community we want to protect!

    1. Pastor Jim November 13, 2020 9:28 pm Reply

      Dr. Jim,

      I very much appreciate your offer of empathy and compassion to those who are suffering financial loss from Covid,, but empathy and compassion are not worth a cup of beans in compare to financial loss of huge proportion especially when heart, soul, blood, sweat, and tears went into a business now lost, when so many others continue to thrive in life due time their positional opposite discrimination, as to which businesses were allowed to remain open.

      But your being a doctor empathy and compassion must be well experienced for your profession, as patients succumb to failed treatments such as so many have and will from covid-19; so much so that the treatment track record may indicate a hands off approach to prescription drug treatment may be indicated as most favorable.

      Perhaps a novel idea for treatment is do nothing and let nature steer the best course of getting patients well with covid-19 patients.

  3. Uncleaina November 12, 2020 7:55 am Reply

    Yea gotta stop saying it’s only residents returning. There’s been at least 4 cases within the past week of non- residents testing negative or “undetermined” and then showing up on our island with Covid. That’s a huge percentage of our cases! It’s like Russian roulette because it’s now a proven fact that the pretest is missing significant numbers of infectious visitors. Mayor K, please step up! This is just about to get completely out of hand with the holidays coming up. Why stay safe for so long to make such dumb mistakes? Look at what has already actually happened – lately about 40-50% of our cases are due to our laxity with inbound visitors. You simply have to do better! Mandate a second test and isolate for first 72 hours or close it all down. Surely anyone with common sense can see what happens next if we keep doing same ol same ol.

  4. Kauaidoug November 12, 2020 8:03 am Reply

    Mr. O’neal,
    I agree 100% although I know some vocal people will cry foul you’re lying or mislead but I don’t think so. EVERY new case can become the beginning of our own shutdown. We have 2 people in the hospital already, wake up!
    All it takes is one person, then it’s the family or roommates then it’s the grocery clerk and on into the community.
    But what really concerns me is everything you stated with infection rates are CURRENT rates on the mainland but if you watched the news this morning the covid mainland map is a see if red and I’m not talking about the election!
    My question and concern is how do infection rates on the mainland (our pool of tourists) affect the number of people slipping through this woefully inadequate system? At what point instead of 3 per thousand does it become 4 or 5 per thousand?
    Europe is off he charts and UK in lockdown till December. Thanksgiving is coming and at least we can sit outside for a carefully monitored turkey dinner as I am planning to celebrate Thanksgiving with friends, hopefully.
    At least we wear our mask as we here in Hawaii on Kaua’i show our Aloha.
    Lucky live Kaua’i and protect our island before it is too late, Mr Mayor!

    1. Kai November 13, 2020 9:11 am Reply

      Mahalo piha, Steve, for your bravery and compassion in bringing this up. Kauai and Maui are at a very dangerous precipice. Due to an insufficient pretest system created for O’ahu but forced on the neighbor islands, we have already gotten to the point of community spread, which we all know from experience is extremely difficult to control. Maui went from zero cases most days to 6 cases the last two days. The DOH will not tell us where the cases are coming from, but I see on the map that it’s not just the touristy places, so I’m guessing it’s at the community spread level already. I saw on the news last night that Kauai now has community spread. COME ON, Mayors, can’t you see the beauty of having COVID-free islands in a nation that is blowing up with infections???

  5. Michelle Tafoya Weinberg November 12, 2020 9:13 am Reply

    Spot on.

  6. John November 12, 2020 10:37 am Reply

    “Stop following those who are not putting your citizen’s interests first.”

    Well, there’s the big monkey wrench in your otherwise valid argument, Steve-O. Kawakami is just a puppet politician installed by Big Airlines and Big Hotels to help THEM generate revenue and growth, even if it is at the expense of our island’s well being. They and he simply do not care that it will probably cost lives by continuing with this idiotic re-opening plan. They consider Death by Covid a casualty of doing business, and any inconvenience or costly measures that complicate their bottom lines, such as quarantines or testings, will be sidelined. Kawakami the career politician DOES NOT CARE and you guys really need to stop deluding yourselves that he does.

  7. RG DeSoto November 12, 2020 10:48 am Reply

    Concerned with bad data? Try this: Click on the “live feed” option and you can scroll through 26 pages of the real, actual data.
    One important takeaway is that the CFR (case fatality rate) is rapidly falling even though the cases are up—this is a worldwide trend. Obviously the SARS Cov2 virus is following the same path that all viruses follow. A peak then rapid fall-off.
    You can see these data described by watching this:

    You: ” Lead us. We’ll support you. Stop following those who are not putting your citizen’s interests first” Speak for yourself, Steve. The political class has done nothing for their citizens except wring the joy out of life and destroying their means for earning a living by a vain attempt to stop the virus. All the while, of course they have been getting full salaries and benefits. How does that help “your citizens’ interests”? Seems to me that the fight against SARS Cov2 is being subsidized by those who can least afford it.
    RG DeSoto

    1. Ah statistics... November 12, 2020 3:39 pm Reply

      If fatalities have a 2 week lag, the immediate effect of rising infection would be to lower the death rate. But wait a couple of weeks…

      1. RG DeSoto November 13, 2020 7:22 am Reply

        You haven’t read or understood the statistical analysis on Both cases and CFRs are from the same periods…ie both are from the two previous weeks so are correlated.
        The statisticians doing this work understand these things and account for them…unlike you two. Keep following the data shown in the live feed in the ensuing days & weeks.
        The point remains: cases may be up but CFRs continue to fall regardless of your misunderstanding of statistics.
        Funny, sad actually, how the panic stricken reject hard data and the good news it carries. Instead they beg to be more controlled by government. Nothing like a jackboot on the neck…right?
        RG DeSoto

        1. TheTosso November 15, 2020 6:35 am Reply

          So, the Soto does read these. Interesting. Personally, I wouldn’t read anything you put forth as a source. I know from your history that it would be a waste of time. That’s what is truly sad – your reputation.

    2. WOH November 12, 2020 4:16 pm Reply

      Well put.

  8. Sam Small November 12, 2020 12:38 pm Reply

    Thank you Steve O’Neal for your excellent, detailed analysis of what must be done to appropriately protect the health and economy of our people.

    Maui also faces the same problem and must seriously look at opting-out of the current, flawed Safe Travels program temporarily in order to reset with proper controls in place and welcome tourists into a sustainable environment rather than the current system which other communities have proven will fail.

    As challenging as it may be in the short term, we can do what is right to protect the long-term viability of tourism on the outer islands and avoid future shutdowns.

    Mr. O’Niel’s proposals will allow us to succeed.

  9. Kama'aina November 12, 2020 1:56 pm Reply

    Your fear of life and focus on death is a narrative that is so sad and misplaced. Covid is here to stay we best get used to living with it just like trillions of other virus’. We will find new ones in know time and will have to live with them as well. The mayor and all the doctors in the world can’t do anything to make you safe. If you sealed your self in a room for any length of time you will be presented with all those virus’ as soon as come out. Take care of your immune system and live life!!!!!!

    1. LMat November 13, 2020 4:46 pm Reply

      Covid is here to stay, we best get used to *dying* with it…

      1. Pastor Jim November 13, 2020 9:44 pm Reply


        The only ones dying are the elderly, under medical care for decades for their end of life diseases, and the prescription drugs burdening them further.

        Along comes a mosquito and bites them on the arm and they blame the mosquito, er, the virus, for the death,

        Decades of medial care combined with end of life disease treatments of toxic prescription drugs is enough to end the life of many a senior citizen regardless or not they have the covid-19 virus.

        This is what you call following the science instead of the spin doctors and vaccine parent scientists.

        1. Citation needed November 15, 2020 6:36 am Reply

          I’d like to see your stats on the ages of those who die from this.

  10. Danni November 12, 2020 3:50 pm Reply

    Such a well written article, with compassion, protection and science as the guiding force. Even if the death rate has been going down, it won’t stay that way. Kauai does not have the medical infrastructure to support this. The mainland is seeing a 35% increase in covid cases in California alone, putting all visitors at a higher risk of contagion.
    Quarantine worked.

  11. Deborah Nantais November 12, 2020 4:48 pm Reply

    Most of the comments so far have been pleading with the Mayor to step back &start locking down the influx of tourists w/out proof of a negative second test.But what is so difficult about the current structure is that incoming passengers are let through w/only a pretest that could have changed significantly by the time they boarded a plane to get here!Then they joy ride throughout the Island come in close contact with so many of us who are just going to the grocery store for milk & eggs!
    I’ve observed little “Aloha” for the locals &their difficulties that it’s simply not worth trying to please or support the tourist trade at this trying time. I add my voice to those who are begging the Mayor to get stricter control over incoming tourists & locals who aren’t willing to quarantine until a 2nd negative test has been given! That test should be free, paid for by Covid monies.

    But, just in case all of our pleas are falling on “deaf” ears, I suggest we all stock up once again as more folks on the Island also reduces the supplies of items Locals (and Kupunas) should be entitled to buying first (by showing local id’s).Mayor we are pleading for you to do the “right thing” before we become another casualty like Lanai Island!

    1. Leite Ovos November 13, 2020 10:00 pm Reply

      Milk and Eggs? Better check your list against the Dairy and Poultry industry dangers in those really manufactured food, who’s animals are treated with toxic prescription drugs to cause non stop production of these foods, as well as their contribution to chronic long term diseases become end of life diseases.

  12. cynthia toth November 12, 2020 4:59 pm Reply

    Thank you Mr. O Neal for a detailed analysis. You are absolutely correct. Kauai should not let their guard down and put in place stricter measures to prevent covid from entering. Medical evidence reports day 7 highest viral load. So by luck if you test at day 4 you might get a few, but you will miss a few too. What’s the end game? Keep covid out, then they need to alter the equation to get a better result that matches the words of keeping covid out. Numbers don’t lie and we thank you for your hard work of making sure folks wake up and have the come to Jesus moment and choose to do the right thing. We want the community to be healthy and the economy to prosper. All of this goes hand in hand.

  13. Dr Stephanie Yan November 12, 2020 6:46 pm Reply

    Steve O Neal’s real world scientific take on this is spot on. For Maui and Kauai it’s esp true. We are not Oahu. Real estate agents on Maui have reported that demand for longer term vacationers escaping the cities surging on the mainland are exceeding inventories. We need stability and these long term vacationers who will pretest, quarantine for 5 to 7 days and test again can and will boost are tourists economy and keep us COVID-19 safe. There’s an alternative market for us. Time to point out that real world testing programs similar to the state’s travel program like what we are doing now in Hawaii hasn’t worked and have ended with shut downs in other places, no matter how you splice the prevalence math. The state’s study design of their 2nd test testing program is so flawed, no other scientist or doctor would agree to itmaking any type of validclaims. Etc etc. AND theLack of true surveillance. Just a waste of millions of dollars that could have gone to unemployment or to help people in need in our communities

    1. Stephen Nay November 13, 2020 11:26 pm Reply

      Dr. Stephanie,

      Your recommendation, like Mayor Derek’s, to welcome the wealthy visitors, which means skip over the average income visitor, here in America that is 2 edged discrimination.
      You see the flip side of your story is that at not only the less income visitor but also the businesses those people can afford to patronize will also be discriminated against.

      How about face reality let the doors open and let the healthy go natural and get the virus and develop their own personal self protection immunity and non contagion, and get out there and protect those who have been irresponsible and/or ignorant about their health, diet, nutrition, and lifestyle, and their medical handlers who should have been physician teaching wellness, instead of the easy prescription drug treatment.

      So now work double time bringing wellness to the high risk elderly left with decades long medically ignored end of life diseases and their concurrent toxic side effect loaded prescription drug treatments.

      Long term decades long Medical prescription drug treatments instead of wellness care has left America being. the sickest nation on earth, even compared to poverty stricken African nations,.

      Our sickest nation status with 80% of our nation’s people taking one or more prescription drugs every day for their diseases, makes us the nation that is proven to be the most susceptible to the flu disease of the Covid19 virus.

      All those decades of sacrificing the health and wellness of our people in lieu of the profits of prescription drug sales, has
      us now in a quandary of accepting Draconian loss of our rights, and subjected to physical and social health deprivation with ineffective mask abuse, e.g., “I can’t breathe “ and the social failure of recognition, and loss of valuable perhaps lifetime relationships and future families.

      All this and more misery because a nation sacrificed its collective health for the easy task, call it lazy, to substitute high profit prescription drug sales for ignoring wellness and restoring and maintaining health.

      Truly a ruination of a nation…!

      And a nation of people abandoned to ignorance of their own bodies and have accepted in return a for profit prescription drug treatment program with no value but the grave loss of their individual life longevity for a sinister system that could have been patented by the devil.

      And the combination of a massive business reliant on disease and their media counterparts holding back the vital information on the age of the people dying with Covid-19 virus and the actual end of life diseases and their medically supervised toxic prescription drug treatments they are taking right up to the last breath and heartbeat.

      We the people knowing almost nothing about the virus and too many afraid to death of it, the virus, yet we know even less, really nothing, about the vaccine, and we want a shot in each arm and follow up booster shots for years sold to billions of people worldwide $$$.

      Why won’t hey tell us this exacting information, people could then make informed infirmation whether to rely on new Wellness Care, or continue with disease care.

  14. Robin November 12, 2020 8:09 pm Reply

    Well written. It had a very unique situation and hopefully we can return to it. The tourists we are getting right now for the most part aren’t ones that care abut protecting Hawaii or they wouldn’t be coming here. We need to require quarantine until a second test done after they arrives proves they are negative.

    You will get a better and more caring group of people if they have to quarantine and have to have a second test to be here. Or just even a 14 day quarantine. We also don’t need just everyone and anyone that wants to come. We all have gotten use to less congestion, less crowds at the beach and most of us have really liked it. We need to aim for more money spent and less people arriving. In the long run it will help all of us have a better island.

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